Minnesota Administrative Rules

5222.2001 CONTENTS OF NOTICE.

Subpart 1.

Form.

Notices relating to policy coverage shall be filed on forms prescribed by the commissioner or as provided in subpart 2. All notices submitted must be typewritten, machine printed, on computer magnetic tape in an approved format, or via electronic transmission using an approved format and protocol as authorized by the commissioner under Minnesota Statutes, section 176.285.

Subp. 2.

Use of declaration sheets.

An insurer's policy declaration sheet or insurance binder may be used in place of forms prescribed by the commissioner if the declaration contains at least the following information:

A.

Type of action, such as new policy, correction, binder, reinstatement, expiration, cancellation, termination, or notice of intent to provide insurance.

B.

Employer's legal name.

C.

Every dba (doing business as) name used by the employer.

D.

Employer's legal form of ownership, such as corporation, partnership, limited partnership, or government entity. All owners or partners must be specifically named. In limited partnerships, only the general partners must be identified.

E.

Employer's complete mailing address, including zip code.

F.

Nature of employer's business.

G.

Policy number.

H.

Effective and expiration dates of policy.

I.

Name of carrier.

J.

Carrier office issuing the policy.

K.

Type of cancellation, if applicable.

L.

Reason for cancellation, if applicable.

M.

Effective date of cancellation, if applicable.

N.

Every employer's federal employer identification number (FEIN) and unemployment account number.

Subp. 3.

Filing not accepted.

Notices not in compliance with this part will not be accepted for filing.

Subp. 4.

Data contract.

A party who contracts with the commissioner for the collection of appropriate insurance coverage data under Minnesota Statutes, section 176.185, subdivision 10, must enter the data elements required subpart 2, and other data elements according to the terms of the contract, in an insurance coverage data base.

Statutory Authority:

MS s 14.388; 176.185; 176.83

History:

11 SR 1505; 17 SR 3364; 35 SR 2015

Published Electronically:

July 6, 2011